More Waits and Delays

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In 2014, the Phoenix VA made national news after veterans were placed on a secret waiting list and had died before receiving an appointment for care. Is it possible in 2018 that this illegal practice is ongoing at some VAs and veterans dying as a result?

The local leadership at Phoenix, including the Director and Chief of Staff, had knowingly allowed the creation of secret waiting lists and concealed them from their superiors. This scandal grew and more authorities investigated and found a similar culture of leadership corruption at other VAs.

Within a short time, then Secretary of Veterans Affairs, four-star general Eric Shinseki, was forced to resign in disgrace. He later admitted that unlike VA Directors, his military commanders were always truthful to him about the state of affairs at their facility.

This month we examine a recently released Office of Inspector General (OIG) report on allegations of waiting list manipulation at the Baltimore VA. As usual, we’ll provide you with confidential insights known by VA employees but not disclosed to the general public.

The OIG first heard of veterans’ care being delayed in 2014 and their initial visit confirmed a number of allegations. First, consults were being canceled in audiology and speech pathology once a patient had an appointment scheduled, regardless of whether the patient was notified of their appointment or showed up.

This is patently illegal per VA consult scheduling guidelines. The whole idea of a consult is to track care and ensure that patients are able to see specialists in a timely manner. Missing an appointment in audiology because a patient requires a hearing aid is very different from missing an appointment because of a sudden complete hearing loss. Consults help distinguish urgent conditions and allow clinicians to track these patients closely.

So why did the service chief overseeing audiology allow them to prematurely close consults? He stated that the VA would not supply him with the necessary staffing and we will accept his word. Medical center directors are often unable or unwilling to prioritize areas of clinical need and instead end up hiring staff for non-essential positions usually of an administrative nature.

What this VA did to correct the problem and what is done at other VAs may surprise you. They got rid of consults. The notion is that patients can simply call and schedule an appointment. But we know from our VA employees that this is a game.  Phones are answered haphazardly and VAs and even the national Crisis line had put veterans on hold. But, no consult means no pesky statistics to track.

Now the VA OIG conducted this investigation over several years and when they went back in 2016, there was better training for staff on consult management and little manipulation was found. However, another problem surfaced.

Nearly thirty percent of consults had been closed without the clerk entering or scanning appropriate medical documentation. This means if a veteran was scheduled to see a provider in the private sector, a so-called non-VA provider, because of specialty staffing shortages at that VA, the consult was quickly closed and outside records were not reviewed.

Both medical providers and patients know how important it is to maintain timely records of care. If a veteran underwent a colonoscopy by a non-VA provider, and was found to have some suspicious polyps that require close follow-up, no one would know. Similarly, a veteran being outsourced for a CT scan might have a suspicious finding, possibly cancerous, that again requires close monitoring.

Unfortunately, the OIG report doesn’t detail the types of records or medical documentation that was lacking in this prematurely closed consults. Let’s hope someone else cared to look.


Prof. Sam

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